Dengue infection in patients presenting with neurological manifestations in a dengue endemic population / Infección de dengue en pacientes que se presentan con manifestaciones neurológicas en una población con dengue endémico

The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study, 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.

La evaluación de la contribución del dengue neurológico en las infecciones virales sospechadas del sistema nervioso central (SNC) resulta esencial para un mejor entendimiento del impacto del dengue neurológico en la morbilidad y mortalidad en regiones donde el dengue es endémico tales como Jamaica. Para este estudio 401 casos de infecciones virales sospechadas del SNC fueron investigados en busca de evidencia de infección por dengue. Se haló entonces que la frecuencia del dengue neurológico entre estos casos de SNC, fue de 13.5% (54/401). Cincuenta y tres casos fueron confirmados por serología mediante ensayos de inhibición de hemaglutinación (IH) y ELISA para la detección de anticuerpos IgM, siendo el virus aislado sólo en un caso. Las manifestaciones clínicas entre los casos que resultaron positivos al dengue, incluyeron encefalitis en 51.8 % (28/54), meningitis en 33.3% (18/54), convulsiones en 11.1% (6/54) y parálisis facial aguda/síndrome Barré Guillain en 3.7% (2/54). El diagnóstico clínico de infección neurológica por dengue estuvo en correspondencia con la confirmación del laboratorio sólo en el 22.2% (12/ 54) de los casos. Se produjeron muertes en el 3.7% (2/54) de los casos, las cuales estuvieron asociadas con pacientes con infección neurológica por dengue. El alto riesgo de dengue entre los pacientes con sospecha de infecciones virales de SNC en este estudio, apunta a la necesidad de aumentar el índice de sospecha de dengue en pacientes que se presentan con manifestaciones neurológicas en países donde el dengue es endémico.

Risk factors for anemia in Vietnam.

Anemia is a significant public health problem in Vietnam, but representative national data and comprehensive risk factors analysis are lacking. The objectives of this study were to: 1) determine the distribution and severity of anemia in Vietnam, and 2) to assess potential risk factors for anemia. Nine thousand five hundred fifty households in 53 provinces were covered using a stratified two-stage cluster survey carried out in 1995. Selected household members were interviewed; intestinal helminthes were tested in non-pregnant women by Kato-Katz technique; hemoglobin concentrations were measured with Hemocue. Data were weighted and analyzed by survey procedures using SAS 9.0. Overall, 60% of children under 2 years old, 53% of pregnant women, 40% of non-pregnant women and 15.6% of men were anemic. Hookworm infection was the strongest factor associated with anemia (OR = 1.7; 2.9 and 4.5 for 11,999, 2,000-3,999 and > or = 4,000 hookworm egg counts, respectively) and accounted for 22% of anemia. Hookworm intensity was significantly associated with hemoglobin level; for each 1,000 egg increase, hemoglobin was reduced by 2.4 g/l. Living in different ecological zones, eating < 1 serving of meat/ week, and farming were significantly associated with anemia in women and children. Other risk factors in women included having > 3 children and having a child < 24 months old. In men, no variables were found significantly associated with anemia.

Intestinal helminth infections among reproductive age women in Vietnam: prevalence, co-infection and risk factors.

Intestinal helminth infections are a significant public health problem for Vietnamese women, but prevalence and risk factor data are scarce. The objectives of this paper were to (1) determine the prevalence of helminth infections among women; (2) investigate interactions among intestinal helminth species in individuals and (3) identify risk factors that contribute to intestinal helminth infections. In a nationwide survey conducted in 1995, 9550 households in 53 provinces were covered using a stratified two-stage cluster survey. Stool specimens were examined by Kato-Katz technique. Of 5,127 women, 76% were infected with one or more helminth species, 36% with hookworm, 59% with Ascaris lumbricoides and 28% with Trichuris trichiura. A. lumbricoides and T. trichiura were more likely to be concurrent than expected by chance. There was significant interaction between prevalence and intensity of infection in all three species. All three helminth species were more common in certain ecologic zones than others. Hookworm infection was associated with farming [Odd ratio (OR) = 2.1] and lack of a closed latrine (OR = 2.0), A. lumbricoides with use of untreated feces as fertilizer (OR = 1.2) and coinfection with T. trichiura (OR = 2.1) and T trichiura with A. lumbricoides co-infection (OR = 2.1). Our findings suggest that reproductive-age women, especially rural farmers, should be included among the high priority groups for helminth control programs through mass chemotherapy and improving sanitation.

Rubella susceptibility in Jamaican women, 1996

The 1995 rubella outbreak in Jamaica indicated a need to survey the susceptibility rate in Jamaican antenatal women at risk. In this 1996 study, 389 women in the reproductive age group were investigated for rubella antibodies. In the public sector urban group (A), rubella susceptibility was 20.2, while in a private sector urban clinic (B) practising routine rubella surveillance and recommending postpartum immunization in seronegatives, the susceptibility rate was 13.8. The latter rate was significantly lower than that in the rural group (C) (35.9; p < 0.001). The overall susceptibility rate was 21.3. Rubella susceptibility has improved overall in women of childbearing age compared with levels in the prevaccine year of 1968. A significant thrust in rubella prevention will still be required before the next rubella epidemic in order to reduce the risk of congenital rubella syndrome.